National Reporting Instrument 2024

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Background

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Hide [BGxINT] Background
Adopted in 2010 at the 63rd World Health Assembly (WHA Res 63.16), the WHO Global Code of Practice on the International Recruitment of Health Personnel (“the Code”) seeks to strengthen the understanding and ethical management of international health personnel recruitment through improved data, information, and international cooperation.

Article 7 of the Code encourages WHO Member States to exchange information on the international recruitment and migration of health personnel. The WHO Director General is mandated to report to the World Health Assembly every 3 years.

WHO Member States completed the 4th round of national reporting in May 2022. The WHO Director General reported progress on implementation to the 75th World Health Assembly in May 2022 (A75/14). The report on the fourth round highlighted the need to assess implications of health personnel emigration in the context of additional vulnerabilities brought about by the COVID-19 pandemic. For this purpose, the Expert Advisory Group on the relevance and effectiveness of the Code (A 73/9) was reconvened. Following the recommendations of the Expert Advisory Group, the Secretariat has published the WHO health workforce support and safeguards list 2023.

The National Reporting Instrument (NRI) is a country-based, self-assessment tool for information exchange and Code monitoring. The NRI enables WHO to collect and share current evidence and information on the international recruitment and migration of health personnel. The findings from the 5th round of national reporting will be presented to the Executive Board (EB156) in January 2025 in preparation for the 78th World Health Assembly.

The deadline for submitting reports is 31 August 2024.

Article 9 of the Code mandates the WHO Director General to periodically report to the World Health Assembly on the review of the Code’s effectiveness in achieving its stated objectives and suggestions for its improvement. In 2024 a Member-State led expert advisory group will be convened for the third review of the Code’s relevance and effectiveness. The final report of the review will be presented to the 78th World Health Assembly.

For any queries or clarifications on filling in the online questionnaire please contact us at WHOGlobalCode@who.int.

What is the WHO Global Code of Practice?

Disclaimer: The data and information collected through the National Reporting Instrument will be made publicly available via the NRI database (https://www.who.int/teams/health-workforce/migration/practice/reports-database) following the proceedings of the 78th World Health Assembly. The quantitative data will be used to inform the National Health Workforce Accounts data portal (http://www.apps.who.int/nhwaportal/).
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Disclaimer

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[1] Note: Case-based facility data collection as that in the WHO Global Bum Registry does not require WHO Member State approval.
[2] The world health report 2013: research for universal coverage. Geneva: World Health Organization; 2013 (http://apps.who.int/iris/bitstream/10665/85761/2/9789240690837_eng.pdf)
[3] WHO statement on public disclosure of clinical trial results: Geneva: World Health Organization; 2015 (http://www.who.int/ictrp/results/en/, accessed 21 February 2018).
For more information on WHO Data Policy kindly refer to http://www.who.int/publishing/datapolicy/en/
I have read and understood the WHO policy on the use and sharing of data collected by WHO in Member States outside the context of public health emergencies
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Contact Details

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Hide [CI] Contact Details
Name of Member State:
Niue
Name of designated national authority:
Peter Fetaui
Title of designated national authority:
Niue Health Service Manager
Institution of the designated national authority:
Niue Ministry of Social Services
Email:
Peter.Fetaui@gov.nu,WHOGlobalCode@who.int,zakojim@who.int,deki@who.int
Telephone number :
4100
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Contemporary issues

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Hide [NRIxI] The questions marked * are mandatory. The system will not allow submission until all mandatory questions are answered.
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Contemporary issues on health personnel migration and mobility
Hide [Q1x1] 1.1 In the past 3 years, has the issue of international recruitment of health personnel been a concern for your country?
Yes, and it is increasing in intensity

We have tried MOU with other Pacific Islands for short-term contracts, we cannot compete with remuneration packages that is offer in other countries.

Hide [Q1x2] 1.2 In the past 3 years, has the issue of international reliance on health personnel (international recruitment of health personnel to meet domestic needs) been a concern for your country?
Yes, and there has been no change in the intensity

We are now looking at the quality of output for the health service deliverables, because Covid19 had taken up a lot of our time, we have lost the day-to-day responsibilities, and quality to deliver UHC. We are now doing own evaluation to see where we are to date. And one of the things we have done is brought on a new Director with the skills and background in this field to review our current standard of Health delivery, and provide capacity to upskill, accessing the right learning institute to do this, and providing one on one mentoring.

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Health Personnel Education

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Health personnel education, employment and health system sustainability
Hide [Q2] 2. Is your country taking measures to educate, employ and retain a health and care workforce that is appropriate for the specific conditions of your country, including areas of greatest need?
Yes
Hide [Q2x1] Please check all items that apply from the list below:
2.1 Measures taken to ensure the sustainability of the health and care workforce
2.2 Measures taken to address the geographical mal-distribution and retention of health and care workers*
2.3 Other relevant measures taken to educate, employ and retain a health and care workforce that is appropriate for the specific conditions of your country
Hide [Q2x1x1] 2.1.1 Measures taken to ensure the sustainability of the health and care workforce
Forecasting future health and care workforce requirements to inform planning
improving our IT system to provide better data, building capacity to be able to be able to utilize the data for future planning and financial forecasting
Aligning domestic health and care workforce education with health system needs
Improving quality of education and health personnel in alignment with service delivery needs
We have provided training through NZ for doctors and Nurses
Creating employment opportunities aligned with population health needs
Managing international recruitment of health personnel
Improving management of health personnel
Setup of Practioner Board is key to develop and manage our Health personnel
Specific provisions on health personnel regulation and recruitment during emergencies
Others
Hide [Q2x2x1] Check all that apply for Measures taken to address the geographical mal-distribution and retention of health and care workers
2.2.1 Education
2.2.2 Regulation
2.2.3 Incentives
2.2.4 Support
Hide [Q2x2x1x1] 2.2.1.1 Education Measure
Education institutions based in rural/underserved areas
Student intake from rural/underserved areas and communities
Scholarships and subsidies for education
Health works have access to Scholarship and subside schemes that requires them to come back for a 2 year period as form of pay back for the funding.
Relevant topics/curricula in education and/or professional development programmes
Attendance of workshop regards to specilized area of Health
(Re)orientation of education programmes towards primary health care
Others
Hide [Q2x2x2x1] 2.2.2.1 Regulation Measure
Scholarships and education subsidies with return of service agreements
bond on returning scholars through health scholarship scheme, for 2 years work at home
Mandatory service agreements with health personnel that are not related to scholarships or education subsidies
Enhanced scope of practice of existing health personnel
Task sharing between different professions
Multi-sectoral collaboration in particular Public Health care
Provisions for pathways to enter new or specialised practice after rural service
Others
Hide [Q2x2x3x1] 2.2.3.1 Incentives Measure
Additional financial reimbursement
Education opportunities
Paid educational fees
Opportunities for career advancement or professional growth
Professional recognition
Social recognition
Opportunity for pathways to permanent residency and/or citizenship for international health personnel
after 10 years, can apply for PR.
Others
Hide [Q2x3x1] 2.3.1 Please describe - Other relevant measures taken to educate, employ and retain a health and care workforce that is appropriate for the specific conditions of your country.
The newly formed Practitioner Board to support personnel development, capacity building, ensuring health workers are keeping up with new advancement in health delivery, and practice. Remuneration, and yearly appraisals, also paid study fees is one of the incentives to encourage potential health workers as a career.
Hide [Q3x1] 3.1 Are there specific policies and/or laws that guide international recruitment, migration and integration of foreign-trained health personnel in your country?
No
Hide [Q3x2] 3.2 Are there any policies and/or provision for international telehealth services in your country through health personnel based abroad?
No
Hide [Q3x3] 3.3 Has your country established a database or compilation of laws and regulations related to international health personnel recruitment and migration and, as appropriate, information related to their implementation?
Hide [Q4] 4. Recognizing the role of other government entities, does the Ministry of Health have mechanisms (e.g. policies, processes, unit) to monitor and coordinate across sectors on issues related to the international recruitment and migration of health personnel?
No
Hide [Q5] 5. Please describe the steps taken by your country to implement the following Code recommendations.
Check all items that apply from the list below:
5.1 Measures have been taken or are being considered to introduce changes to laws or policies on health personnel consistent with the recommendations of the Code.
5.2 Actions have been taken to communicate and share information across
sectors on the international recruitment and migration of health personnel, as well as to publicize the Code, among relevant ministries, departments and agencies,
nationally and/or sub-nationally.
5.3 Measures have been taken to consult stakeholders in decision-making
processes and/or involve them in activities related to the international recruitment of health personnel.
5.4 Records are maintained on all private recruitment agencies for health
personnel authorized by competent authorities to operate within their jurisdiction.
5.5 Good practices, as called for by the Code, are encouraged and promoted among private recruitment agencies.
5.5a Promotion of the Code among private recruitment agencies.
5.5b Domestic legislation or policy requiring ethical practice of private recruitment agencies, as consistent with the principles and articles of the Code.
5.5c Public or private certification of ethical practice for private recruitment agencies.
5.5d Others
5.6 None of the above
Thier is fragments of CODE practices in place, but more needs to be done.
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Government Agreements

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Government-to-Government agreements on migration or mobility of health personnel
Hide [Q6] 6. Has your country or sub-national governments entered into any bilateral, multilateral, or regional agreements and/or arrangements with respect to the international recruitment and/or mobility of health personnel?
Yes
Hide [Q6x1xA] 6.1 A Please use the table below to describe each of the active bilateral, regional or multilateral agreements or arrangements:
a. Title of Agreement b. Type of Agreement
Agreement 1 MOU with Solomons Island 3
Agreement 2
Agreement 3
Agreement 4
Agreement 5
Agreement 6
Agreement 7
Agreement 8
Agreement 9
Agreement 10
Agreement 11
Agreement 12
Agreement 13
Agreement 14
Agreement 15
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Government Agreements - 6.1 A

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Hide [Q6x1xAx1] c. Countries involved
MOU with Solomons Island
NIU
Hide [Q6x1xAx2] d. Coverage
MOU with Solomons Island
National
Hide [Q6x1xAx3] e. Main focus of agreement (check all that apply)
Education and training Health cooperation Promotion of circular migration Philanthropy or technical support Qualification recognition Recruitment of health personnel Trade in services Others
MOU with Solomons Island 1
Hide [Q6x1xAx4] f. Categories of Health Personnel (check all that apply)
Doctors Nurses Midwives Dentists Pharmacists Other occupations
MOU with Solomons Island 1
Hide [Q6x1xAx5] g. Validity period
Start Year End Year
MOU with Solomons Island 2024 TBC
Hide [Q6x1xAx6] h. Signatory of the agreement from your country
MOU with Solomons Island
Ministry of Health
Hide [Q6x1xAx7] i. Signatory of the agreement from the partner country (ies)
MOU with Solomons Island
Ministry of Health
Hide [Q6x1xAx8] j. Content of agreement
Hide [Q6x1xAx8x1] j.i. Does the agreement include elements to benefit the health system of your country and the partner country(ies)?
MOU with Solomons Island
Yes, has elements to
benefit the health system of my country only
Hide [Q6x1xAx8x1x] Please explain:
MOU with Solomons Island
labor mobility
Hide [Q6x1xAx8x2] j.ii. Does the agreement include elements on health worker rights and welfare?
MOU with Solomons Island
Yes
Hide [Q6x1xAx8x2x] Please explain:
MOU with Solomons Island
accommodation, salary, flights to and back, and insurance, but I dont know the details
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Government Agreements - 6.1 B

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Hide [Q6x1xB] 6.1 B Please use the table below to describe the implementation of each of the active bilateral, regional or multilateral agreements or arrangements
Hide [Q6x1xBx1] Has the agreement been implemented?
MOU with Solomons Island
No
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Responsibilities, rights and recruitment practices

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Responsibilities, rights and recruitment practices
Hide [Q7] 7. If your country employs/hosts international health personnel to work in the health and care sectors, which legal safeguards and/or other mechanisms are in place for migrant health personnel and to ensure that enjoy the same legal rights and responsibilities as the domestically trained health workforce?
Please check all items that apply from the list below:
Migrant health personnel are recruited using mechanisms that allow them to assess the benefits and risk associated with employment positions and to make timely and informed decisions on the employment.
Through centralized government employment sector, in collaboration with health
Migrant health personnel are hired, promoted and remunerated based on objective criteria such as levels of qualification, years of experience and degrees of professional responsibility on the same basis as the domestically trained health workforce.
This is through a interview process.
Migrant health personnel enjoy the same opportunities as the domestically trained health workforce to strengthen their professional education, qualifications and career progression.
If a migrate health worker has migrated and living in Niue
Institutional arrangements are in place to ensure safe migration/ mobility and integration of migrant health personnel.
This needs to be strengthen
Measures have been taken to promote circular migration of international health personnel
This needs to be strengthen
Other measures (including legal and administrative) for fair recruitment and employment practices of foreign-trained and/or immigrant health personnel (please provide details)
This is in their contract that they have agreed on the terms and conditions.
No measures in place
Not applicable – does not host/employ foreign health personnel
Hide [Q8] 8. If health personnel from your country are working abroad in the health and care sectors, please provide information on measures that have been taken or are planned in your country to ensure their fair recruitment and employment; safe migration; return; and diaspora utilization in your country, as well as difficulties encountered.
Please check all items that apply from the list below:
Arrangements for fair recruitment
Arrangements for decent employment contracts and working conditions in destination countries
Arrangements for safe mobility
Arrangements for return and reintegration to the health labour market in your country
Arrangements for diaspora engagement to support your country health system
Other
If a Health worker from our own country decides to work overseas, they bare the requirements that is needed to do so.
No measures in place
Not applicable – health personnel from my country are not working abroad
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International migration

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International migration and mobility pathways for health personnel
Hide [Q9x1] 9.1 If your country hosts international health personnel to work in the health and care sector, how do they come to your country? (check all that apply)
Direct (individual) application for
education,
employment, trade, immigration or
entry in country
Government to
government
agreements that
allow health
personnel mobility
Private
recruitment
agencies or
employer
facilitated recruitment
Private education/ immigration
consultancies
facilitated mobility
Other pathways (please specify) Which pathway is used the most? Please include quantitative data if available.
Doctors 1 0 0 0
Nurses 0 1 0 0
Midwives 0 1 0 0
Dentists 1 0 0 0
Pharmacists 1 0 0 0
Other occupations 0 0 0 0
Other occupations 0 0 0 0
Other occupations 0 0 0 0
Other occupations 0 0 0 0
Other occupations 0 0 0 0
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Hide [Q9x2] 9.2 If health personnel from your country work/study abroad, how do they leave your country? (check all that apply)
Direct (individual) application for
education,
employment, trade,
immigration, or
entry in the
destination country
Government to
government
agreements that
allow health
personnel mobility
Private
recruitment
agencies or
employer
facilitated recruitment
Private education/ immigration
consultancies
facilitated mobility
Other pathways (please specify) Which pathway is used the most? Please include quantitative data if available.
Doctors 0 0 1 1
Nurses 0 0 0 1
Midwives 0 0 0 0
Dentists 0 0 1 1
Pharmacists 0 0 0 1
Other occupations 0 0 0 0
Other occupations 0 0 0 0
Other occupations 0 0 0 0
Other occupations 0 0 0 0
Other occupations 0 0 0 0
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Recruitment & migration

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Data on international health personnel recruitment & migration


Improving the availability and international comparability of data is essential to understanding and addressing the global dynamic of health worker migration. Please consult with your NHWA focal point, if available, to ensure that data reported below is consistent with NHWA reporting*.
(The list of NHWA focal points is available here. Please find the focal point(s) for your country from the list and consult with them.)

For countries reporting through the WHO-Euro/EuroStat/OECD Joint data collection process, please liaise with the JDC focal point.

Hide [Q10] 10. Does your country have any mechanism(s) or entity(ies) to maintain statistical records of foreign-born and foreign-trained health personnel?
Yes
Hide [Q10x1] 10.1 Where are the records maintained? (check all that apply)
Employment records or work permits
Ministry of health personnel database
Registry of health personnel authorized to practice
Other
Hide [Q10x2] 10.2 Does the record include gender-disaggregated data on the foreign-born and/or foreign-trained health personnel?
Yes
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Inflow and outflow of health personnel

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Hide [INFOx7] Inflow and outflow of health personnel
Hide [Q11] 11. Do you have a mechanism to monitor the inflow and outflow of health personnel to/from your country? (check all that apply)
Inflow
Outflow
No
Hide [Q11xI] If yes for inflow:
Fill in the table below
Hide [Q11x1] 11.1 How many foreign-trained or foreign-born health personnel were newly active (temporarily and/or permanently) in your country in the past three years (inflow)?
Doctors Nurses Midwives Dentists Pharmacists Remarks
2021 2 2 1
2022 5
2023 1 2 1 1
Data Source (e.g. Regulatory authority, immigration records, work permits, etc.)
Hide [Q11xO] If yes for outflow:
Fill in the table below
Hide [Q11x2] 11.2 How many domestically trained health personnel left your country in the past years for temporary or permanent migration (outflow)?
Doctors Nurses Midwives Dentists Pharmacists Remarks
2021 1 1
2022 1 1
2023 1 2 1
Data Source (e.g. letters of good standing, emigration records, government to government agreements etc.)
Hide [Q11x3] 11.3 If you have any document with information on health worker inflows and outflows for your country, please upload
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Stock of health personnel

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Hide [INFOx8] Stock of health personnel
Hide [Q12x1] 12.1 Consolidated stock on health personnel, disaggregated by place of training and birth
For the latest year available, consistent with the National Health Workforce Accounts (NHWA) Indicators 1-07 and 1-08, please provide information on the total stock of health personnel in your country (preferably the active workforce), disaggregated by the place of training (foreign-trained) and the place of birth (foreign-born).
Hide [Q12x1a] Please provide data on the stock of active health personnel in your country by one of the following ways:
Fill in the table below
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Total Place of training-Domestic Trained Place of training-Foreign trained-total Place of training-Foreign trained-national born Place of training-Foreign trained-foreign born Place of birth-National Born Place of birth-Foreign Born Data Source* Year of data Does the data represent active stock? Does the data represent active stock?
Medical Doctors (generalist + specialists) 4 0 4 2 2 2 2 2024 10 1
Nurses 15 0 15 7 8 7 8 2024 10 1
Midwives 0 0 0 0 0 0 0 2024 0 1
Dentists 2 0 2 1 1 1 1 2024 10 1
Pharmacists 1 0 1 1 0 1 0 2024 20 1 Still finalizing the Niue Health Practional Board
Hide [Q12x1x1x] If you have any document with information on stock of active health personnel for your country, their distribution by place of training and place of birth, please upload
Hide [Q12x2] 12.2 Please provide data on the top 10 countries of training for foreign-trained health personnel in your country.
This information can be provided by one of the following two options:
Fill in the table below
Hide [Q12x2x1]
Doctors Nurses Midwives Dentists Pharmacists
Total foreign trained personnel 4 15 0 2 1
Country 1: Top country of training FJI FJI NZL FJI FJI
Country 1: No. of foreign trained health personnel 4 15 0
Country 2: Top country of training TON NZL FJI FJI FJI
Country 2: No. of foreign trained health personnel 1 4 0
Country 3: Top country of training FJI FJI NZL FJI FJI
Country 3: No. of foreign trained health personnel 0
Country 4: Top country of training FJI FJI NZL FJI FJI
Country 4: No. of foreign trained health personnel 0
Country 5: Top country of training FJI FJI NZL FJI FJI
Country 5: No. of foreign trained health personnel 0
Country 6: Top country of training FJI FJI NZL FJI FJI
Country 6: No. of foreign trained health personnel 0
Country 7: Top country of training FJI FJI NZL FJI FJI
Country 7: No. of foreign trained health personnel 0
Country 8: Top country of training FJI FJI NZL FJI FJI
Country 8: No. of foreign trained health personnel 0
Country 9: Top country of training FJI FJI NZL FJI FJI
Country 9: No. of foreign trained health personnel 0
Country 10: Top country of training FJI FJI NZL FJI FJI
Country 10: No. of foreign trained health personnel 0 0
Source (e.g. professional register, census data, national survey, other) Professional registration Professional registration None Professional registration Professional registration
Year of data (Please provide the data of the latest year available) 2024 2024 2024 2024 2024
Remarks All Doctors trained over seas All Nurses are trained over seas All Midwives train overseas All Dentist train over seas All Pharmacists train Overseas
Hide [Q12x2x1x] If you have any document with information on the distribution of foreign-trained health personnel for your country by their country of training, please upload
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Technical and financial support

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Technical and financial support
Hide [Q13] 13. Has your country provided technical or financial assistance to any source countries or countries in the WHO health workforce support and safeguards list 2023, or other low- and middle-income countries on health workforce development, health system strengthening, or for implementing other recommendations of the Code (e.g., strengthening data, information and research on health workforce for translation to policies and planning, etc.)
No
Hide [Q14] 14. Has your country received technical or financial assistance from any WHO Member State or other stakeholders (e.g., development partners, other agencies) for health workforce development, health system strengthening, or for implementing other recommendations of the Code (e.g., strengthening data, information and research on health workforce for translation to policies and planning, etc.)?
Yes
Hide [Q14x] Please provide additional information below (check all that apply):
Support for health workforce development (planning, education, employment, retention)
Support for other elements for health system strengthening (service delivery; health information systems; health financing; medical products and technology; and health leadership and governance)
Other areas of support:
Hide [Q14x1] Please specify support for health workforce development (planning, education, employment, retention)
Supporting country/entity Type of support (please specify)
Niue Scholarship support for education training
Hide [Q14x2] Please specify support for other elements of health system strengthening (service delivery; health information systems; health financing; medical products and technology; and health leadership and governance)
Supporting country/entity: Type of support (please specify)
Niue Health leadership and governance, Implementation of the Niue Health Practitioner’s Board (NHPB), May 2024. Assisted with our planning to obtain Technical Assistance to help develop training criterias for Health Professionals registered into the Board.
Niue Medical products and technology, Commissioning of the Oxygen Plant & training of staff to operate and monitor the plant.
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Constraints, Solutions, and Complementary Comments

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Constraints, Solutions, and Complementary Comments
Hide [Q15] 15. Please list in priority order, the three main constraints to the ethical management of international migration in your country and propose possible solutions:
Main constraints Possible solutions/recommendations
Accommodation and transport Hospital to build own village facility for migrate workers, partner with NGO to help run facility.
insurance for migrate workers build into bilateral agreements insurance for migrate workers
Hide [Q16] 16. What support do you require to strengthen implementation of the Code?
Support to strengthen data and information on health personnel
Training on IT, build local capacity within the country
Support for policy dialogue and development
Help incorporate into local policy
Support for the development of bilateral/multi-lateral agreements
Placed as a priority for all bilateral/ multi-lateral within agreement discussions
Others
No support required
Hide [Q17] 17. Considering that the Code is a dynamic document that should be updated as required, please provide reflections from your country on the past 14 years since the resolution on the Code.
Hide [Q17x1] Please comment on if/how the Code has been useful to your country.
The code provides valuable insight and guidance but is mostly loss within countries own governance and policies, that are similar in its content, provides a recognized module of practice but more enforceable, even by law, hence why the code generally loss behind current existing procedures.
Hide [Q17x2] Do any articles of the Code need to be updated?
No

perhaps provide data on where it is currently been adopt.

Hide [Q17x3] Does the process of reporting on Code implementation and the review of the Code relevance and effectiveness need to be updated?
No

Hide [Q17x4] Please comment on the WHO health workforce support and safeguards list (e.g. if your country is included in the list, how has that affected you; if your country is reliant on international health personnel, how has the list affected you; if your country is not in the list, how has it affected you)
Our country is not on the list, but we should be asking of the quality of delivery
Hide [Q18] 18. Submit any other complementary comments or material you may wish to provide regarding the international recruitment and migration of health personnel, as related to implementation of the Code.

Please describe OR Upload (Maximum file size 10 MB)
Our country needs to use the code to revise our own standards and ensure we are using best practice to support migrate workers and to provide the means of security while helping to deliver Health Care coverage for all.
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Warning

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Hide [WARN] You have reached the end of the National Reporting Instrument - 2024. You may go back to any question to update your answers or confirm your entry by clicking ‘Submit’.